Topics in Geriatrics: Managing Knee Osteoarthritis in the Older Adult Knee osteoarthritis (OA) is a condition which affects approximately 47% of adults over the age of 60. (1) There is now a clinical prediction rule (CPR) to help Physical Therapists identify individuals with Knee OA who will have a significant short term benefit from hip mobilizations. Objectives:The objectives of this page are to:
Learn more about the knee OA CPR
Learn about which individuals with knee OA will benefit from hip mobilizations.
Learn about which hip mobilizations patients were treated with in this CPR
Learn about which individuals should not receive hip mobilizations
Learn about the evidence related to hip mobilizations as a treatment for knee OA
Obtain access to evidence related to additional treatments for knee OA
Information About the Test, Condition or Topic The Clinical Prediction Rule for the use of hip mobilizations to manage knee OA OA involves the degradation of joints, including articular cartilage, subchondral bone, ligaments, the capsule and synovial membrane degeneration. This will eventually lead to pain and loss of function.(2) Over 30% of adults 60 years of age and older have knee OA which results in some form of limitation in their daily activities which include difficulty with walking, sit to stand transfers, and stairs.(3)The purpose of this clinical prediction rule is to help identify individuals with knee OA who will have a favorable short term response to hip mobilizations. Individuals who met the following criteria used in this CPR and received hip mobilizations showed a short term benefit of a 30% reduction in pain at a 2 day follow up. The CPR developed in this study is comprised of 5 variables: (1) Hip or groin pain or paresthesia (2) Anterior thigh pain (3) Passive knee flexion less than 122 degrees (4) Passive hip medial (internal) rotation less than 17 degrees (5) Pain with hip distraction Utilizing the CPR variables, with 1 variable present the probability of a successful response 48hrs post treatment is 92%, and with 2 variables present the probability of success increases to 97%. (4)
Who should I apply the CPR for the use of hip mobilizations to? Individuals who have a definitive diagnosis of knee OA including symptoms of knee crepitus, palpable bony enlargement, bony tenderness to palpation, morning stiffness less than 30min, and no palpable warmth of the synovium were included in the making of this CPR. (5) This criteria developed by Altman et al. can be helpful for therapists to identify those individuals with knee OA without access to a radiographic diagnosis of OA.
Which mobilizations were used in the development of the CPR? The four hip mobilizations used were a caudal glide, anterior-posterior glide, posterior-anterior glide, and posterior anterior glide with flexion, abduction and external rotation. Detailed descriptions of the hip mobilizations including pictures can be found here: https://d269i4ytkc080m.cloudfront.net/content/ptjournal/87/9/1106/F1.large.jpg
Who should not receive hip mobilizations? Hip mobilizations are not appropriate for everyone. According to Maitland, some absolute contraindications for joint mobilizations include: malignancy in the area of treatment, infectious arthritis, metabolic bone disease, neoplastic disease, fusion or ankyloses, osteomyelitis, and fracture/ligament rupture. Some relative contraindications to joint mobilizations include: excessive pain or swelling, arthroplasty, pregnancy, hypermobility, spondylolisthesis, Rheumatoid Arthritis, and vertebrobasilar insufficiency. (6,7) The authors of this CPR also excluded individuals who had a primary complaint of low back pain or who had back pain radiating below the knee. If a patient has any of the above conditions you should consider another treatment approach for their knee OA. Additional Resources on the Management of Knee OA Link to hip mobilizations CPR: http://ptjournal.apta.org/content/87/9/1106.long Exercise as a treatment for knee OA: http://ptjournal.apta.org/content/90/6/839 Aquatic PT as a treatment for knee OA: http://ptjournal.apta.org/content/87/1/32 Motivation and behavior changes for patients with knee OA: http://www.apta.org/PTinMotion/News/2015/11/16/OAAANovember2015/ Systematic Review of PT interventions for knee OA: http://ptjournal.apta.org/content/88/1/123
References
Leyland KM, Hart DJ, Javaid MK, Judge A, et al. The natural history of radiographic knee osteoarthritis: a fourteen-year population-based cohort study. Arthritis Rheum 2012;64(7):2243-51.
J. W-P. Michael, et al., The Epidemiology, Etiology, Diagnosis, and Treatment of Osteoarthritis of the Knee, Deutsches Ärtzeblatt International, 2010, 107(9): 152–162
Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60:91–97
Currier, L. L., Froehlich, P. J., Carow, S. D., et al. Development of a Clinical Prediction Rule to Identify Patients With Knee Pain and Clinical Evidence of Knee Osteoarthritis Who Demonstrate a Favorable Short-Term Response to Hip Mobilization. Physical Therapy,2007. 87(9)1106-1119.
Altman R, Asch E, Bloch D, et al, for the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29:1039–1049.
Knee osteoarthritis (OA) is a condition which affects approximately 47% of adults over the age of 60. (1) There is now a clinical prediction rule (CPR) to help Physical Therapists identify individuals with Knee OA who will have a significant short term benefit from hip mobilizations.
Objectives:The objectives of this page are to:
Information About the Test, Condition or Topic
The Clinical Prediction Rule for the use of hip mobilizations to manage knee OA
OA involves the degradation of joints, including articular cartilage, subchondral bone, ligaments, the capsule and synovial membrane degeneration. This will eventually lead to pain and loss of function.(2) Over 30% of adults 60 years of age and older have knee OA which results in some form of limitation in their daily activities which include difficulty with walking, sit to stand transfers, and stairs.(3)The purpose of this clinical prediction rule is to help identify individuals with knee OA who will have a favorable short term response to hip mobilizations. Individuals who met the following criteria used in this CPR and received hip mobilizations showed a short term benefit of a 30% reduction in pain at a 2 day follow up. The CPR developed in this study is comprised of 5 variables:
(1) Hip or groin pain or paresthesia
(2) Anterior thigh pain
(3) Passive knee flexion less than 122 degrees
(4) Passive hip medial (internal) rotation less than 17 degrees
(5) Pain with hip distraction
Utilizing the CPR variables, with 1 variable present the probability of a successful response 48hrs post treatment is 92%, and with 2 variables present the probability of success increases to 97%. (4)
Who should I apply the CPR for the use of hip mobilizations to?
Individuals who have a definitive diagnosis of knee OA including symptoms of knee crepitus, palpable bony enlargement, bony tenderness to palpation, morning stiffness less than 30min, and no palpable warmth of the synovium were included in the making of this CPR. (5) This criteria developed by Altman et al. can be helpful for therapists to identify those individuals with knee OA without access to a radiographic diagnosis of OA.
Which mobilizations were used in the development of the CPR?
The four hip mobilizations used were a caudal glide, anterior-posterior glide, posterior-anterior glide, and posterior anterior glide with flexion, abduction and external rotation. Detailed descriptions of the hip mobilizations including pictures can be found here: https://d269i4ytkc080m.cloudfront.net/content/ptjournal/87/9/1106/F1.large.jpg
Who should not receive hip mobilizations?
Hip mobilizations are not appropriate for everyone. According to Maitland, some absolute contraindications for joint mobilizations include: malignancy in the area of treatment, infectious arthritis, metabolic bone disease, neoplastic disease, fusion or ankyloses, osteomyelitis, and fracture/ligament rupture. Some relative contraindications to joint mobilizations include: excessive pain or swelling, arthroplasty, pregnancy, hypermobility, spondylolisthesis, Rheumatoid Arthritis, and vertebrobasilar insufficiency. (6,7) The authors of this CPR also excluded individuals who had a primary complaint of low back pain or who had back pain radiating below the knee. If a patient has any of the above conditions you should consider another treatment approach for their knee OA.
Additional Resources on the Management of Knee OA
Link to hip mobilizations CPR: http://ptjournal.apta.org/content/87/9/1106.long
Exercise as a treatment for knee OA: http://ptjournal.apta.org/content/90/6/839
Aquatic PT as a treatment for knee OA: http://ptjournal.apta.org/content/87/1/32
Motivation and behavior changes for patients with knee OA: http://www.apta.org/PTinMotion/News/2015/11/16/OAAANovember2015/
Systematic Review of PT interventions for knee OA: http://ptjournal.apta.org/content/88/1/123
References